不同临界点血清转铁蛋白受体对小儿缺铁性贫血的诊断价值

目的探讨血清转铁蛋白受体(sTfR)在儿童缺铁性贫血(IDA)诊断中的意义。方法6个月~12岁缺铁性贫血儿童50例及正常儿童20例均进行血红蛋白(Hb)、sTfR、血清铁蛋白(SF)、血清铁(SI)、总铁结合力(TIBC)测定,并将受测对象分为正常对照组(C组)、轻度IDA组(IDA1组)、中~重度IDA组(IDA2组),以不同浓度sTfR为临界点计算其诊断IDA的敏感度及特异度以确定最佳的诊断临界点。结果以sTfR浓度40nmol/L为缺铁性贫血的诊断标准时,其敏感度和特异度分别为90%和85%,为敏感度和特异度之和最大的临界点。结论当sTfR为40nmol/L时诊断IDA准确度最高,即为IDA的最佳临界点。     

血清转铁蛋白受体对小儿缺铁性贫血诊断的意义

缺铁性贫血(iron deficiency anemia,IDA)是小儿的常见病。诊断缺铁的生化指标很多,但都不同程度地受病理生理因素的影响。近年来机体铁代谢调节及铁状况评价方法的研究取得了很大进展,其中血清转铁蛋白受体(sTfR)测定方法的建立和应用,提高了铁缺乏及IDA诊断的敏感性、特异性和可靠性…。本课题对正常儿童及IDA儿童进行sTfR及其他铁参数及血红蛋白(Hb)的测定,计算以不同sTfR为临界点时诊断IDA的敏感度及特异度,以确定最佳诊断临界点,以研究sTfR在儿童IDA诊断中的意义。     

血锌原卟啉和血清转铁蛋白受体测定对合并感染的缺铁性贫血患儿的诊断价值

目的　研究血锌原卟啉 (ZPP)和血清转铁蛋白受体 (sTfR)测定在合并感染的缺铁性贫血患儿中的诊断价值。方法　 1999～ 2 0 0 2年华中科技大学同济医学院附属同济医院采用血液荧光测定仪测定ZPP ,酶联免疫吸附试验法测定血清转铁蛋白受体 ,检测了 6 0例合并常见感染性疾病的缺铁性贫血 (IDA)患儿 ,设为感染合并IDA组 ,Hb( 70 4± 2 1 7)g/L。同时检测了 2 0例患同类感染性疾病的血红蛋白正常患儿 ,设为对照组 ,Hb( 12 3 1± 10 2 ) g/L。结果　ZPP :对照组为 ( 0 5 4± 0 18) μmol/L ,而感染合并IDA组为 ( 2 5 5± 1 72 ) μmol/L ,明显高于对照组 ( t=8 71,P <0 0 0 1)。血清转铁蛋白受体 :对照组为 ( 7 0 9± 2 32 )mg/L ,感染合并IDA组为 ( 2 4 4 0± 17 84 )mg/L ,亦显著高于对照组 (t =7 33,P <0 0 0 1)。结论　两种诊断IDA的新指标ZPP和sTfR受感染因素的影响较小 ,在合并常见感染性疾病的IDA患儿中 ,仍可作为诊断铁缺乏的良好指标     

血清转铁蛋白受体

血清转铁蛋白受体（。TfR）是近年来转铁蛋白受体（TfR）研究的一个新领域。自1986年KOgO等首次证实其存在以来,STfR在血液病临床实践中的意义日益受到重视,成为评价机体铁状况及红细胞生成的一项新指标。一、STfR的发现、来源及其特征TfR是细胞膜上的一种跨膜糖蛋白,主要功能是与转铁蛋白结合,从而将铁摄人细胞内。TfR广泛分布于机体所有细胞,在增殖活跃的细胞、合成Hb的幼红细胞及胎盘绒毛滋养层合体细胞膜上,TfR数目尤为丰富,以适应这些细胞对铁的需要。研究证明,正常情况下人体总铁量的4／5都供幼红细胞合成Hb,且经Tf…     

血红蛋白H病患儿血清可溶性转铁蛋白受体水平的研究

目的 分析小儿血红蛋白H病（HbH病）血清可溶性转铁蛋白受体（sTfR）水平,探讨其与HbH病贫血程度的关系。方法 纳入55例HbH病患儿以及30例正常健康儿童（对照组）为研究对象,回顾性分析缺失型、非缺失型HbH病组以及对照组的血液学指标与血清sTfR水平。结果 55例HbH病中,缺失型39例,非缺失型16例。缺失型与非缺失型HbH组血红蛋白（Hb）、平均红细胞体积（MCV）、平均血红蛋白含量（MCH）均低于对照组（P < 0.05）,血清sTfR水平均高于对照组（P < 0.05）。非缺失型HbH病组红细胞（RBC）、Hb水平低于缺失型HbH病组（P < 0.05）,而MCV、MCH以及血清sTfR水平高于缺失型HbH病组（P < 0.05）。HbH病患儿血清sTfR水平与RBC、Hb水平呈负相关（r分别为-0.739、-0.667,均P < 0.05）;而与MCV、MCH呈正相关（r分别为0.750、0.434,均P < 0.05）。结论 血清sTfR水平与HbH病患儿贫血程度相关,可能是HbH病治疗的一个靶点。     

可溶性转铁蛋白受体在儿童铁缺乏症诊断中的价值

目的：调查6个月至7岁各年龄段儿童铁缺乏症的发生率;评价可溶性转铁蛋白受体（sTfR）在儿童铁缺乏症筛查中的应用价值。方法：采用诊断性试验方法,检测浙江省杭州市502例来我院体检的6个月至7岁儿童血清sTfR、铁蛋白(SF)、血清铁(SI)、总铁结合力（TIBC）以及C反应蛋白（CRP）水平,同时检测血常规和血锌原卟啉（ZPP）。结果：铁缺乏症的检出率为19.5%（98/502）,其中婴儿组（≤1岁）检出率为34.7%,幼儿组（大于1岁、小于或等于3岁）19.4%,学龄前组（大于3岁、小于或等于7岁）14.0%。婴儿组铁缺乏的检出率明显高于其他两个年龄组。婴儿组sTfR均值（2.02±0.73 mg/L）明显高于幼儿组（1.68±0.40 mg/L）和学龄前组（1.67±0.29 mg/L）,差异有统计学意义（P<0.05）。sTfR诊断铁缺乏的界值在婴儿组为2.02 mg/L（灵敏度70.3%,特异度 82.2%）,幼儿组为1.85 mg/L(灵敏度71.7%,特异度86.4%),学龄前组为1.85 mg/L（灵敏度77.8%, 特异度88.6%)。sTfR与SF、TIBC、TS、ZPP及MCV具有相关性（r分别为0.107、0.276、-0.139、0.175、-0.140,P均<0.05）。结论：7岁以下儿童中,婴儿组是铁缺乏发生率最高的;婴儿组sTfR均值及其诊断铁缺乏的界值均高于其他年龄组;sTfR是诊断儿童尤其是婴儿铁缺乏症的一个较敏感指标。     

血清铁蛋白在缺铁性贫血并感染中的诊断价值

目的 研究血清铁蛋白(SF)在并感染的缺铁性贫血(IDA)患儿中的诊断价值。方法 采用酶联免疫吸附试验,检测60例感染性疾病IDA患儿SF,其中38例骨髓铁染色显示铁缺乏患儿为A组[Hb(62.9±21.3)g／L],22例未做骨穿检查患儿为B组[Hb(83.3±16.4)g／L];同时检测20例患同类感染性疾病Hb正常患儿为对照组。结果 对照组SF为(170±150)μg／L,A组和B组分别为(40±32)μg／L、(53±37)μg/L,A、B组均明显低于对照组(P均<0.01)。在有骨髓铁染色作为金标准A组中,若分别以SF<14μg／L、<60μg／L、<100μg／L作为诊断界点,诊断缺铁敏感度分别为15.8％、73.7％、92.1％,约登指数分别为0.26、0.52、0.57,以SF<100μg／L为诊断界值准确性最好;在B组中若以同样几个界点作为判断缺铁标准,其敏感度分别为18.2％、63.6％、95.5％,约登指数为0.18、0.43、0.61,与A组相似。结论 在并感染性疾病的贫血患儿中,建议可将SF<100μg／L作为判断IDA的依据。     

血清转铁蛋白受体和促红细胞生成素与急性白血病患儿贫血关系的研究

血清转铁蛋白受体 (ｓＴｆＲ)是细胞转铁蛋白受体 (ＴｆＲ)的一个可溶性片段 ,在一定程度上可反映细胞ＴｆＲ的数量。已有研究表明 ,ＴｆＲ在红系细胞、高度增殖细胞 (包括肿瘤细胞 )和低分化细胞表达较高[1,2 ] 。血清促红细胞生成素(ｓＥＰＯ)可以反映体内ＥＰＯ的生成能力 ,受骨髓造血前体细胞总量的影响。二者均与红细胞生成密切相关。贫血是小儿白血病的主要临床表现之一 ,目前有关白细胞贫血的机制尚未完全被阐明。 2 0 0 0年 9月～ 2 0 0 1年 7月 ,我们探讨了急性白血病 (ＡＬ)患儿ｓＴｆＲ和ｓＥＰＯ与白血病贫血的关系 ,报道如下。…     

缺铁小儿血清转铁蛋白受体变化及其意义

为探讨血清中可溶性转铁蛋白受体（sTfR）在缺铁性贫血诊断中的意义，用单克隆及多克隆双抗体夹心ELISA法测定正常对照组、隐性缺铁组、红细胞生成缺铁组、轻度缺铁性贫血组、中～重度缺铁性贫血组小儿sTfR。结果分别为4．0±1．1、5．3±1.1、7.2±1.2、94±2.6、14.9±5.3mg／L，各组均数比较及两两比较均有显著性差异。分析sTfR及血清铁蛋白（SF）在各组间的动态变化，发现对照组与隐性缺铁组间SF差值最大，sTfR变化则远不及SF；随着缺铁继续加重，SF保持低水平上的相对恒定；sTfR则迅速升高。此结果提示SF是诊断隐性缺铁最敏感的指标，sTfR则为诊断红细胞生成缺铁及缺铁性贫血的可靠指标，并可量度贮存铁耗竭后继续铁缺失的严重程度。     

转铁蛋白受体、铁蛋白及铁调节蛋白-1 mRNA 在铁缺乏胎儿胎盘中的表达

目的探讨铁转运相关蛋白mRNA在胎儿铁缺乏(ID)胎盘中的表达。方法根据脐血血清铁蛋白(SF)水平将研究对象分为ID组和铁充足(IS)组。采用RT-PCR方法测定两组胎盘转铁蛋白受体(TfR)、铁蛋白(Fn)和铁调节蛋白-1(IRP-1)mR- NA表达情况。结果 1．ID组TfR mRNA为1 10±0．26,明显高于IS组(t=0．028 P<0.05);2．ID组Fn mRNA为0．304± 0 095,明显低于IS组(t=0.014 P<0．05);3．ID组IRP-1 mRNA为0．278±0.073,与IS组无统计学差异(t=0．086 P> 0．05);4．胎盘TfR mRNA和脐血SF自然对数呈明显负相关(r=0.558 P<0 05),而Fn mRNA与脐血SF自然对数呈明显正相关(r=0．502 P<0．05)。结论胎儿ID时胎盘TfR mRNA表达升高,Fn mRNA减少,IRP-1 mRNA无明显变化,可最大程度地保证胎儿铁供应的相对恒定。     

Deficiencies in the Management of Iron Deficiency Anemia During Childhood

Limited high‐quality evidence supports the management of iron deficiency anemia (IDA). To assess our institutional performance in this area, we retrospectively reviewed IDA treatment practices in 195 consecutive children referred to our center from 2006 to mid‐2010. The majority of children were ≤4 years old (64%) and had nutritional IDA (74%). In 11‐ to 18‐year‐old patients (31%), the primary etiology was menorrhagia (42%). Many were referred directly to the emergency department and/or prescribed iron doses outside the recommended range. Poor medication adherence and being lost‐to‐follow‐up were common. Substantial improvements are required in the management of IDA.     

Red Cell Distribution Width in the Diagnosis of Iron Deficiency Anemia

Objective: 1. To compare peripheral smear (PS) and Red cell distribution width (RDW) in diagnosis of Iron deficiency anemia (IDA) in various grades. 2. To study the changes in RDW and PS after therapy.Methods : Children in the age group of six months to five years with microcytic (MCV < 80fl) anemia (Hemoglobin < 11g%) were evaluated. Those who had received blood transfusion and /or were already on iron therapy were excluded. Evaluation included clinical examination, complete blood count (CBC), RDW estimation microscopic examination of peripheral smear, measurement of serum iron and transferrin saturation. Children with IDA were treated with oral iron for 8 weeks and PS, CBC including RDW were repeated.Result: Of the 100 children evaluated, 89 had IDA. 48% had mild, 42% had moderate and 10% had severe anemia. Transferrin saturation correlated with severity of anemia. Peripheral smear showed microcytosis and hypochromia in all cases with severe anemia, 61.5% and 22.5% of those with moderate and mild anemia respectively. RDW was suggestive of iron deficiency in 100%, 82.05% and 100% of patient with mild, moderate and severe anemia respectively.Conclusion : In the diagnosis of mild and moderate iron deficiency anemia, RDW had a higher sensitivity than PS. Red cell morphology, Hb, PCV and RDW showed significant improvement after iron-therapy     

Serum transferrin receptor levels in the evaluation of iron deficiency in the neonate

Iron deficiency anemia (IDA) is a major global problem. Early onset of iron deficiency in developing countries makes it imperative to identify iron deficiency in neonates. Most conventional laboratory parameters of iron status fail to distinguish neonates with iron deficient erythropoiesis. Serum transferrin receptor (STFR) levels are a recent sensitive measure of iron deficiency and the present study was carried out to evaluate the usefulness of cord serum transferrin receptors in identifying iron deficient erythropoiesis in neonates. A complete hemogram, red cell indices, iron profile: serum iron (SI), percent transferrin saturation (TS%) and serum ferritin (SF) was carried out in 100 full-term neonates and their mothers at parturition. Cord and maternal STFR levels were estimated using a sensitive enzyme-linked immunosorbent assay (ELISA) technique. Anemic women had a significantly lower SI, their TS% and high STFR levels suggesting that iron deficiency was responsible for the anemia. In the neonates of iron deficient mothers, cord SI, TS% and cord ferritin were not significantly different from those of neonates born to non-anemic mothers. Cord STFR level correlated well with hemoglobin (Hb) and laboratory parameters of iron status, and its level was significantly higher in neonates born to anemic mothers than in those bom to non-anemic mothers. It was the only laboratory parameter to differentiate between neonates bom to anemic and non-anemic mothers. Therefore, STFR is a sensitive index of iron status in neonates and identifies neonates with iron deficient erythropoiesis.     

Serum soluble transferrin receptor is a valuable diagnostic tool in iron deficiency of breath-holding spells

Iron-deficiency anemia may be a factor contributing to breath-holding spells. The serum transferrin receptor provides a useful measure of tissue iron deficiency. In this study of 50 breath-holders, while iron-deficiency anemia was detected in 28 (56%) of patients with routine tests, serum transferrin receptor levels were found increased in all patients. A positive correlation was detected between serum soluble transferrin receptor levels and frequency of attacks. It is suggested that the serum transferrin receptor level is useful as a single test for identification of iron deficiency in breath-holders. Moreover, if iron deficiency can be diagnosed earlier, then patients can be treated earlier.     

Diagnostic Yield of Upper Gastrointestinal Endoscopy in the Evaluation of Iron Deficiency Anemia in Older Children and Adolescents

Iron deficiency anemia (IDA) is frequent in childhood. Inadequate nutrition and gastrointestinal malabsorption are the frequent causes of IDA in children. But reduced iron absorption and insidious blood loss from the gastrointestinal tract has been identified as the most frequent causes of IDA in older children and adolescents. Therefore the authors evaluated the frequency and etiologies of the upper gastrointestinal system pathologies causing IDA in older pediatric population. Patients with known hematological or chronic diseases, heavy menstrual flow, and obvious blood loss were excluded from the study. Forty-four children between the ages of 9.5 and 17.5 years and diagnosed with IDA were enrolled. They underwent upper gastrointestinal endoscopy and biopsy from esophagus, stomach, and duodenum. Mean age and hemoglobin (Hb) levels of study group (32 boys, and 12 girls) were 14.6 ± 2.0 years and 7.9 ± 1.8 g/dL, respectively. Only 1 patient had a positive serology testing with anti-tissue transglutaminase and small bowel biopsy correlating with celiac disease. Endoscopy revealed abnormal findings in 25 (56.8%) patients (21 endoscopic antral gastritis, 2 active duodenal ulcers, and 2 duodenal polyps). Helicobacter pylori (HP) infection was identified by using antral histopathological evaluation in 19 of 44 children (43.2%). In 2 of duodenal samples, one patient had celiac disease, and the other one was diagnosed as giardiasis. In conclusion, there are different etiologies resulting in IDA in older children and adolescents. When older children and adolescents are found to have iron deficiency, HP infection and other gastrointestinal pathologies should be ruled out before iron deficiency treatment.     

Iron Deficiency in Infants and Toddlers in the United States

Iron deficiency anemia (IDA) continues to be overwhelmingly the leading cause of anemia in early childhood and a global public health challenge. Although there has been a significant decrease in the frequency of IDA and iron deficiency (ID) in infants and toddlers in recent years in the United States, ID and IDA persist and the adverse effects of ID are long-lasting if not permanent. Moreover, ID can result in lead toxicity, and this toxic exposure, even with low levels, can impair neurocognitive function as well. This review describes the major steps that have taken place to decrease the frequency of ID and IDA.     

Evaluation of erythropoiesis by serum transferrin receptor and ferritin in infants aged 0-6 months

The aim of this study was to evaluate erythropoiesis in 198 healthy babies aged 0-6 months by determination of their blood count, serum transferrin receptor (STfR), and ferritin levels. Anemia and microcytosis were present in 9% and 13% of the sample, respectively. Microcytosis rate was as high as 45% in 6-month-old babies. In infants with normal blood counts, the values of sTfR/ferritin and sTfR-F index were increasing with the increase of sTfR and decrease of ferritin beginning from 2 months of age. In the 5- to 6-month-old group, sTfR concentrations, sTfR/ferritin ratio, and sTfR-F index were higher in infants with anemia and microcytosis. This research showed a high frequency of iron deficiency detected in otherwise healthy babies. Only problems with early weaning practices were found to be significantly more common in babies with iron deficiency.     

Iron Deficiency Anemia in Children Presenting with Lymphoreticular Malignancies and the Effect of Induction Therapy

There is scant information regarding iron deficiency in children with malignant disorders. Serum iron status of children with lymphoreticular malignancies (LRMs) at onset and at the end of induction therapy, compared to the normal population, was evaluated. Prospective cohort study conducted between July 2002 and March 2004. Previously untreated children recently diagnosed with LRM were studied. Age-matched controls were enrolled from follow-up and growth monitoring clinics. Hematological (complete blood counts and red cell indices) parameters and markers of iron status (serum iron, serum ferritin, total iron binding capacity) were estimated at presentation and at the end of remission induction therapy, that is, 5 weeks after initial evaluation. Bone marrow iron store were only assessed in cases. Thirty-five children (31 with acute lymphoid leukemia, 2 with acute myeloid leukemia, and 2 with non-Hodgkin lymphoma; 27 boys and 8 girls; 2 to 12 years of age) were evaluated in the study cohort. Anemia was documented in 80% of children with LRM. Iron deficiency was an important etiological factor. In the majority of cases therapy resulted in significant improvement towards normalization of deranged hematological parameters. This phenomenon could be attributed to enhanced quantity and quality of erythropoietic activity and red cell transfusions. The observation suggests that therapeutic iron supplements are not indicated in the majority of children on therapy for malignant disorders. Various hematological and body iron status parameters should be assessed on a case-by-case basis.